Healthcare Provider Details

I. General information

NPI: 1265291223
Provider Name (Legal Business Name): LOGAN REID CUMMINGS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MCLEAN HOSPITAL 115 MILL ST
BELMONT MA
02478
US

IV. Provider business mailing address

29 BIGELOW ST APT 2
CAMBRIDGE MA
02139-2394
US

V. Phone/Fax

Practice location:
  • Phone: 617-855-2000
  • Fax:
Mailing address:
  • Phone: 207-409-7241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10001972
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: